Provider Demographics
NPI:1184194474
Name:MEJIA, MARBELLA
Entity Type:Individual
Prefix:
First Name:MARBELLA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26081 MOCINE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2923
Mailing Address - Country:US
Mailing Address - Phone:510-300-3500
Mailing Address - Fax:510-881-5925
Practice Address - Street 1:2201 WOOLSEY ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1832
Practice Address - Country:US
Practice Address - Phone:317-989-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician